A course of radiotherapy is often given after surgery to kill any remaining breast cancer cells and reduce the risk of recurrence. Breast cancers usually recur close to the site of the original cancer (the tumour bed) so scientists are investigating options for delivering radiotherapy more precisely to this area, thereby reducing damage to surrounding tissue.

Currently X-rays are used to direct radiotherapy treatment to the critical area however they reveal only the position of surrounding organs and bones and not the exact location of the tumour bed. A safety margin must therefore be added to ensure the tumour bed always falls in the treatment area, with the result that a high dose of radiotherapy has to be given to twice as much healthy breast tissue as would otherwise be necessary.

In the latest study, known as IMPORT-IGRT, patients will have the walls of their surgical excision cavity marked with small titanium clips that can be seen in x-ray images. This will allow the tumour bed to be more precisely located and radiotherapy can be given to a smaller amount of breast tissue.

The study, led by Professor Philip Evans from the ICR, will measure the accuracy of radiotherapy that makes use of IGRT compared with standard imaging. The scientists will evaluate how effective the IGRT technique is in reducing the volume of tissue treated at a high dose, and determine the consequent reductions in risk to normal tissue compared with the standard technique.

“Our pilot studies suggest that safety margins around the tumour bed can be greatly reduced, leading us to expect a lower rate of long-term complications such as breast shrinkage, hardness, pain and rib fracture,” says Professor Evans. “In this study, we will be able to calculate exactly how much breast tissue we were able to spare and the implications this will have on side-effects.”

The study builds on an ongoing trial called IMPORT-HIGH, which is led by Professor John Yarnold of the ICR and Dr Charlotte Coles of Addenbrooke’s Hospital. IMPORT-HIGH is recruiting 840 women across the UK who are at average or above risk of breast cancer coming back, to compare the effectiveness of standard radiotherapy to the whole breast with radiotherapy more precisely targeted to the tumour bed using IGRT. IMPORT-IGRT aims to recruit 250 women from the original IMPORT-HIGH study.

The ICR has been ranked the UK’s top academic research centre, based on the results of the Higher Education Funding Council’s Research Assessment Exercise.

The ICR works closely with partner The Royal Marsden NHS Foundation Trust to ensure patients immediately benefit from new research. Together the two organisations form the largest comprehensive cancer centre in Europe.

The ICR has charitable status and relies on voluntary income, spending 90 pence in every pound of total income directly on research.

As a college of the University of London, the ICR also provides postgraduate higher education of international distinction.

Over its 100-year history, the ICR’s achievements include identifying the potential link between smoking and lung cancer which was subsequently confirmed, discovering that DNA damage is the basic cause of cancer and isolating more cancer-related genes than any other organisation in the world.

The ICR is home to the world’s leading academic cancer drug development team. Several important anti-cancer drugs used worldwide were synthesised at the ICR and it has discovered an average of two preclinical candidates each year over the past five years.

The Efficacy and Mechanism Evaluation programme supports later-phase “science-driven” clinical trials and evaluative studies, which seek to determine whether a health intervention (e.g. a drug, diagnostic technique or device) works and in some cases how or why it works.

The Efficacy and Mechanism Evaluation programme (www.eme.ac.uk ) is funded by the Medical Research Council and managed by the National Institute for Health Research

The NIHR provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk

The Medical Research Council is dedicated to improving human health through excellent science. It invests on behalf of the UK taxpayer. Its work ranges from molecular level science to public health research, carried out in universities, hospitals and a network of its own units and institutes. The MRC liaises with the Health Departments, the National Health Service and industry to take account of the public’s needs. The results have led to some of the most significant discoveries in medical science and benefited the health and wealth of millions of people in the UK and around the world. www.mrc.ac.uk

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